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The average age of SCAD survivors is 42. Nearly 80% percent of known SCAD patients are women, with 20 percent experiencing their dissection in the peripartum period, either late in pregnancy or in the weeks after having a baby. The remaining women appear to experience SCAD related to extreme exertion or associated conditions such as fibromuscular dysplasia (FMD) or connective tissue disorders, such as Marfan or Ehlers Danlos syndrome (Type IV). Hormone fluctuations also may play a role.
SCAD in men appears to be triggered by extreme physical exertion (e.g., fitness boot camps, triathlons) or the associated conditions as well. SCAD patients overall have none of the typical risk factors associated with other causes of heart attack, such as high blood pressure or plaque rupture from cholesterol build up.
In addition to identifying SCAD’s associated conditions, early research has uncovered facts that prove the urgent need for targeted research and educating the medical community to take a closer look at younger patients exhibiting heart attack symptoms. Contrary to popular belief, SCAD survivors can experience additional dissections, ranging from days to a decade after the original event. Most subsequent SCADs occur in a different vessel. Second or third SCADs have been seen in arteries other than the coronaries, including the femoral and internal carotid arteries. The recurrence rate of SCAD is estimated to be 21%.
SCAD may occur when a combination of factors and conditions occur as a “perfect storm.” Associated conditions of SCAD such as vascular irregularity, hormonal influences, collagen/genetic defect (e.g., Marfan, Ehlers Danlos, other connective tissue disorder), and physical exertion may interact or be subsets of each other.
If emergency medical professionals look beyond the patient’s age and fitness to suspect SCAD, then there is hope for successful treatment. If the medical team sends the patient home with an antacid or treats the blockage as a classic plaque rupture, the end results can be deadly.
Differentiating SCAD from atherosclerosis is difficult on a standard angiogram — particularly if the cardiologist does not suspect SCAD as a possible cause. New imaging techniques such as optical coherence tomography (OCT, pictured here) and intravascular ultrasound (IVUS) aid in accurate diagnosis because the “true” and “false” channels of pooled blood caused by the dissection are seen, not mistaken for plaque. (Unfortunately, however, OCT and IVUS are not available in all hospitals.)
If the cardiologist perceives the SCAD to be a standard plaque blockage, he or she may try stent placement, which can cause additional tearing in an artery prone to dissect. Alternately, if the cardiologist sees the dissection and pooled blood, the treatment of choice may be medication management, which allows the clot to resorb and the dissection to gradually heal.
Each SCAD patient is unique. As research advances, progress will be made toward standards regarding conservative treatment, stents, and bypass surgery. SCAD Alliance Scientific Advisory Board is working toward guidelines for accurate diagnosis and care.
The vital role of the Emergency Department in improving outcomes of SCAD.
For more on the importance of symptom recognition and prompt emergency medical care, please read this SCAD Alliance Scientific Advisory Board white paper: here.